The presence and outcome of biliary sphincter disorders in liver-transplant recipients according to the Rome IV classification

Abstract

Background Biliary sphincter disorders after liver transplantation (LT) are poorly described. We aim to describe the presence and outcome of patients with papillary stenosis (PS) and functional biliary sphincter disorders (FBSDs) after LT according to the updated Rome IV criteria. Methods We reviewed all endoscopic retrograde cholangiopancreatographies (ERCPs) performed in LT recipients between January 2003 and December 2019. Information on clinical and endoscopic findings was obtained from electronic health records and endoscopy databases. Laboratory and clinical findings were collected at the time of ERCP and 1 month after ERCP. Results Among the 1,307 LT recipients, 336 underwent 849 ERCPs. Thirteen (1.0%) patients met the updated Rome IV criteria for PS [former sphincter of Oddi dysfunction (SOD) type I] and 14 patients (1.0%) met the Rome IV criteria for FBSD (former SOD type II). Biliary sphincterotomy was performed in 13 PS and 10 FBSD cases. One month after sphincterotomy, bilirubin, gamma-glutamyl transferase and alkaline phosphatase levels decreased in 85%, 61%, and 92% of those in the PS group (P = 0.019, 0.087, and 0.003, respectively) and in 50%, 70%, and 80% of those in the FBSD group (P = 0.721, 0.013, and 0.093, respectively). All the 14 patients initially suspected of having a FBSD turned out to have a different diagnosis during the follow-up. Conclusions PS after LT is uncommon and occurs in only 1% of LT recipients. Our data do not support the presence of an FBSD after LT. Sphincterotomy is a safe and effective procedure in LT recipients with PS.

Biliary complications after liver transplantation: A computed tomography and magnetic resonance imaging pictorial review

“…SOD type I) accounting for about 1% of cases and suspected functional biliary sphincter disorder ( i.e. SOD type II) for about 1% as well[ 39 ]. The pathogenesis of biliary sphincter disorder in liver transplantation recipients is poorly understood; possible predisposing factors include the use of a T-tube, the presence of opportunistic infection, and postsurgical edema[ 40 , 41 ].…”

“…Sphincter of Oddi manometry has been the gold standard for years, although it is invasive, patient- and operator-dependent, and may lead to post-procedure pancreatitis. Due to these factors, it is no longer routinely used in all patients with suspected SOD and its general utility has been questioned[ 39 - 41 ]. Hepatobiliary scintigraphy can demonstrate structural or functional partial biliary obstruction as evidenced by increased time to hepatic peak, delayed biliary visualization, delayed clearance of the radiotracer from the dilated bile ducts, and prolonged biliary to bowel transit[ 42 - 44 ].…”

Dysfunction of Biliary Sphincter of Oddi—Clinical, Diagnostic and Treatment Challenges

“…As a structural abnormality, biliary SOD is classified according to Milwaukee classification into types 1, 2 and 3 based on clinical presentation as well as laboratory and/or imaging abnormalities; see Table 1 [8,11,12,14,[29][30][31][32][33]. Diagnosis of type 3 SOD is challenging due to the lack of significant abnormalities on laboratory testing or diagnostic imaging.…”